• Pirouz Piran and Robert D Stevens.
• Departments of Anesthesiology and Critical Care Medicine, Neurology, Radiology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• Curr Opin Crit Care. 2021 Apr 1; 27 (2): 115-119.

Purpose Of ReviewThe coexistence of neurological injury and respiratory failure is common in intensive care. This article provides a contemporary overview of the safety and efficacy of different strategies for mechanical ventilation and adjunctive respiratory approaches in patients with acute brain injury.Recent FindingsAvailable evidence indicates that lung-protective ventilation (LPV) can be implemented safely in a range of patients with concurrent respiratory failure and brain injury of different etiologies; however, the clinical efficacy of LPV in this setting needs to be established. In patients who have severe acute respiratory distress syndrome (ARDS) and brain injury, adjunctive measures (neuromuscular blocker drug infusions, prone positioning, extracorporeal membrane oxygenation) may be considered, although the neurophysiological impact and safety of these techniques need further investigation. Intracranial pressure and other neuromonitoring techniques may be of value to ensure optimal management of mechanical ventilation and adjunctive measures in this population.SummaryResearch is needed to determine the safety, feasibility, and efficacy of LPV and adjunctive approaches for managing patients with concurrent brain injury and respiratory failure.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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